Care Needs and Caregivers: Associations and Effects of Living Arrangements on Caregiving to Older Adults in India

Social relationships and subjective wellbeing of the older adults in India: the moderating role of gender

OBJECTIVE

Social relationships have been extensively researched as having compelling health benefits. Nevertheless, these issues are understudied in low-income countries like India. This study investigates whether intergenerational solidarity or the social relationship developed in the household context and social participation or the social relationships developed in the community context are the critical determinants of subjective wellbeing (SWB) of older adults in India. In addition, this study also investigates whether gender moderates the association between social relationships and subjective wellbeing (SWB).

METHODS

This study utilises a latent variable approach to investigate the association between social relationships and SWB among older adults (aged 60 or older, N = 9,852) based on a cross-sectional analysis of data from Building a Knowledge Base on Population Ageing in India (BKPAI) (2011). I tested the moderating effect of gender by employing a multigroup analysis in structural equation modelling that incorporated social relationships and other predictors of SWB.

RESULTS

The study suggests that social participation has a significant protective impact on elderlies' SWB, and gender doesn't moderate the relation. Intergenerational solidarity has a significant health protective impact on older adults' SWB; there is a significant moderating impact of gender. Specifically, functional and consensual solidarity have significant moderating effects of gender. Affectional solidarity, although a significant predictor of older adults' SWB, and gender don't moderate the relation.

CONCLUSION

The study suggests taking into account a variety of social relationships as well as gender roles when attempting to understand SWB at a later age. The results are discussed in terms of how gender roles impact social relationships and how men and women evaluate SWB differently based on those relationships.

Socioeconomic Determinants of Anticipated and Actual Caregiving for Older Adults in India

This study investigates adult children's informal caregiving for, and living arrangements with, older parents in urban India. We differentiated between anticipated caregiving, for respondents whose parents and parents-in-law do not currently need care, and actual caregiving, for respondents who have at least one parent or parent-in-law with care needs. The results based on the 2011 Osaka University Preference Parameters Study reveal different antecedents of anticipated and actual care. Females have lower odds of anticipated care but there were no gender differences in actual caregiving. Married people have higher odds of anticipating financial assistance, but lower odds of providing actual caregiving. Religiosity is positively related to anticipated care and co-residing but not actual caregiving. Wealth increases the odds of anticipating providing housework as well as anticipated and actual financial assistance, while decreasing the odds of actual care. Given these findings, strengthening public pension and long-term care services is warranted.

Social capital and well-being of the elderly 'left-behind' by their migrant children in India

BACKGROUND

The study aims to examine the association between individual forms of social capital and the well-being of the elderly 'left-behind' parents and to determine if there is a gender difference within the possible relationship.

METHODS

This study applied the first wave of the Longitudinal Ageing Study in India (LASI, 2017-18) data. In this study, the respondents were 4,736 older parents 'left-behind' by their migrant adult sons. We employed descriptive statistics and bivariate analysis to assess the study sample's characteristics. The proportion test was performed to examine if there was a significant gender difference among older adults regarding depression, ADL, and IADL impairments. In addition, binary logistic regression was utilized to investigate the associations between social capital and elderly parents' health outcomes.

RESULTS

This study found a significant gender difference in depression (male: 8.26%; female:11.32%; P < 0.001), ADL (male:20.23%; female:25.75%; P = 0.032), and IADL (male: 33.97% female: 54.13%; P < 0.001) limitations. Elderly parents who did not participate in any social activity had a higher odd of ADL (aOR: 2.44; 95%CI: 1.882-3.171; P = < 0.001) and IADL (aOR: 1.22; 95%CI: 1.034-1.766 ; P = < 0.001) limitations. Networking with friends through phone/email conversations has a substantial impact on lowering depression in older parents. Older adults with good personal social capital were less likely to have depression, ADL, and IADL limitations.

CONCLUSION

Personal social capital is closely associated with the well-being of left-behind older parents. More efforts should be in place to increase the stock of social capital in this group with focused gender disparity.

Prediction model of quality of life using the decision tree model in older adult single-person households: a secondary data analysis

Background

Attention is drawn to the subjective health status and quality of life of older adult single-person households, whose number is gradually increasing as factors including low fertility, increased life expectancy, aging, and household miniaturization interact.

Objective

The study was to identify predictors that affect the quality of life of single-person households aged 65 years or older and living in South Korea.

Methods

A secondary data analysis design was used. Data included physical, mental, social, and demographic characteristics, subjective health status, and quality of life parameters of 1,029 older adult single-person households surveyed by the Korea Health Panel in 2019. For analysis, the predictive model was evaluated using split-sample validation and the ROC curve. The area under the curve after the decision tree analysis was calculated. Final nodes predicting the quality of life of older adult single-person households were derived.

Results

Significant predictors were identified in this order: subjective health status, chronic disease, income, and age. Subjective health status was the most important factor influencing quality of life (△ p < 0.001, x2 = 151.774). The first combination that perceived high quality of life of older adult single-person households was the case of high subjective health status and no chronic disease, followed by the case of high subjective health status, presence of chronic disease, and high income.

Conclusion

This study confirmed that subjective health status and chronic disease are essential factors for quality of life among the four related indicators of quality of life presented by the OECD. In nursing practice, nurses need to pay attention the factors influencing quality of life of older adult single-person households. Especially, nursing practice for older adult single-person households needs to be focused on improving subjective health status and on relieving chronic disease.

Neighborhood socioeconomic position, living arrangements, and cardiometabolic disease among older Puerto Ricans: An examination using PREHCO 2002-2007

Cardiometabolic diseases are among the leading causes of mortality worldwide and are increasingly prevalent in rapidly aging populations. Neighborhood socioeconomic position (SEP) and living arrangements are increasingly recognized as important determinants of cardiometabolic health but have not been examined within Puerto Rico. This study examined the association between neighborhood SEP, living arrangements, and incidence of cardiometabolic conditions among island-dwelling older Puerto Ricans, using longitudinal data from the Puerto Rican Elderly Health Conditions Project (Waves I 2002/03 and II 2006/07) linked with 2000 Census data for neighborhood-level conditions. Our sample consists of non-institutionalized adults aged 60 and older who remained in the same residence over both waves of data collection (N = 2,769). We used multilevel multinomial logistic regression models to examine the relationship between neighborhood SEP and the prevalence and incidence of cardiometabolic disease. Findings show that residence in a socioeconomically advantaged neighborhood was positively associated with reporting having one cardiometabolic condition at baseline, but not associated with the incidence of cardiometabolic conditions at follow-up. Living without a partner was negatively associated with reporting having cardiometabolic conditions compared to living with a partner. Similar results were found for the incidence of cardiometabolic conditions. Living arrangements significantly modified the relationship between neighborhood SEP and cardiometabolic conditions. Compared to living with a partner, living alone in a socioeconomically advantaged neighborhood was associated with a reduced risk of reporting having one condition. Living with children in a socioeconomically advantaged neighborhood was associated with a reduced risk of developing one cardiometabolic condition than living with a partner. Living arrangements are more salient to cardiometabolic health than neighborhood SEP. Social programs and services focused on household composition and familial support are needed to identify older Puerto Ricans potentially at risk of underdiagnosed chronic conditions, especially as ongoing economic, demographic, environmental, and healthcare crises potentially exacerbate social inequalities.

In search of a fix to the primary health care chasm in India: can institutionalizing a public health cadre and inducting family physicians be the answer?

India's woes with an underprioritized and hence underfunded and understaffed public health system continue to plague public healthcare delivery. Though the need for appropriately qualified public health cadre to lead public health programmes is well established, a well-meaning conducive approach to implementing this is lacking. As the COVID-19 pandemic brought back the focus on India's fragmented health system and primary healthcare deficiencies, we discuss the primary healthcare conundrum in India in search of a quintessential fix. We argue for instituting a well-thought and inclusive public health cadre to lead preventive and promotive public health programmes and manage public health delivery. With the aim being to increase community confidence in primary health care, along with the need to augment primary healthcare infrastructure, we argue for a need to augment primary healthcare with physicians trained in family medicine. Provisioning medical officers and general practitioners trained in family medicine can salvage community's confidence in primary care, increase primary healthcare utilization, stymie over-specialization of care, channelize and prioritize referrals, and guarantee competence in healthcare quality for rural communities.

Exploring the positive aspects of caregiving among family caregivers of the older adults in India

Background

Caregiving is a committed role that focuses on providing the required support and care to a care receiver who is either ill, disabled, or dependent to the extent that they are incapable of independent functioning. The topic of caregiving has been extensively studied worldwide, mainly focused on the negative aspects of caregiving, like caregiver stress, burden, role conflicts, and burnout among caregivers. However, limited efforts have been made to understand the positive aspects of caregiving among informal caregivers who spend most of their time in this unpaid role. The present study addresses this concern by exploring the positive aspects of caregiving among family caregivers of older persons in India.

Methodology

This is a qualitative study, which was conducted, using the existential-phenomenological approach. In this study, a purposive sampling technique was used, and a total of a 100 family caregivers participated from four cities in India, namely Prayagraj, Pune, Visakhapatnam, and Guwahati. Twenty-five family caregivers between the age of 30-50  years participated from each of these four cities. The data was collected using six semi-structured interview questions on positive aspects of caregiving based on the lived experiences of caregivers. The interview schedule was developed based on the PERMA model and finalized after the pilot study. Each interview took 30-50 min and was recorded and transcribed.

Results

The data was analyzed using thematic analysis. Some commonalities and differences were observed in the responses given by family caregivers from the four cities. Four major themes that emerged for the "Nature of positive caregiving" among participants from all four cities are "Caregiver's attitude," "Care and compassion," "Roles and responsibilities," and "Beliefs and values." Four significant themes for the "Factors contributing to positive caregiving" are "Meaningfulness in life," "Sense of belongingness," "Personal growth," and "Empathetic understanding."

Conclusion

Based on the study's findings, it can be said that the themes were associated with the PERMA model. Positive caregiving is an important indicator of caregivers' and care receivers' well-being. The findings have implications for planning some action research, training, and counseling programs for promoting positive aspects of caregiving among informal caregivers.

Caregiving: a risk factor of poor health and depression among informal caregivers in India- A comparative analysis

BACKGROUND

In an ageing society, the provision of long-term care is the prime need. In Indian cultural setting, family members are the informal, albeit primary caregivers to the elderly. Caregiving demands intense emotional and financial involvement. While taking care of elderly persons' health and wellbeing, these family members, acting as informal caregivers, may themselves become vulnerable to poor health due to additional stress and burden. Using a nationally representative survey, the study tried to identify how health condition varies within caregivers and a comparative analysis of how in similar socio-economic background health condition varies between caregivers and non-caregivers.

METHOD

The data, used for the analysis, is taken from Longitudinal Ageing Study in India (LASI), Wave I. Both descriptive and multivariable regression analysis are done in different models along with interaction effect of caregiving to understand the difference in health status between caregiver and non-caregivers.

RESULTS

Nearly 29% and 11% of the informal caregivers, reported to have depressive symptoms and poor self-rated health (SRH), respectively. Almost half of the caregivers, who provide care for more than 40 h a week, are diagnosed to have depressive symptoms. They are also at higher risk of having depressive symptoms (AOR 1.59 CI 1.16-2.18) and poor SRH (AOR 1.73 CI 1.11-2.69) than those who invest less than 40 h in a week. In almost every socio-economic condition, caregivers are at a higher risk of having depression and poor health than non-caregivers. Caregivers, who are widowed, live in rural areas or are not satisfied with current living arrangement are more vulnerable to have depressive symptoms. On the other hand, caregivers of age 45-59 years, widowed, male and who live only with their children with spouse absent, have almost 2 times higher odds of poor SRH than non-caregivers.

CONCLUSION

Caregivers are more susceptible to depression and poor self-rated health compared to non-caregivers irrespective of their socio-economic characteristics, only the magnitude of vulnerability varies.

Caregiver burden in older Indian patients with cancer- Experience from a tertiary care center

INTRODUCTION

Most of the long-term care for older adults with chronic or debilitating illnesses is provided by unpaid family members or informal caregivers. There is limited information on caregiver burden among caregivers of older patients with cancer in India. Hence, we assessed the prevalence and severity of caregiver burden among caregivers of older Indian patients with cancer.

METHODS

This was an observational study conducted at the geriatric oncology clinic at Tata Memorial Centre, Mumbai, India. Caregivers of patients aged 60 years and over with a diagnosis of cancer were assessed for caregiver burden using the Zarit Burden Interview. Descriptive statistics were used for demographic and clinical variables. Factors impacting caregiver burden were analyzed using multiple linear regression analysis.

RESULTS

Caregiver burden was assessed among 127 caregivers of older Indian patients with cancer. The median patient age was 69 years (range 60-90). Most patients were men (75.6%). There were 33 female caregivers (26%), and 94 male caregivers (74%). The median caregiver burden score was 12 (IQR 6-20). Caregiver burden was "little/none" in 97 (76.4%), "mild-moderate" in 25 (19.7%), "moderate-severe" in four (3.1%) and "severe" in one (0.8%) of the caregivers assessed. On multivariate analysis, factors that significantly impacted caregiver burden scores were the presence of psychological issues in the patient and the caregiver's educational level.

CONCLUSION

Caregiver burden was low among caregivers of older Indian patients with cancer seen at a single center. Caregivers of patients with psychological disorders, and those who had less schooling reported higher caregiver burden.

Coresidence increases the risk of testing positive for COVID-19 among older Brazilians

Background

Brazil is among the countries hit hardest by COVID-19, and older adults are among the vulnerable groups. Intergenerational coresidence and interdependence among family members, both prevalent in Brazil, likely increase social and physical contact and thus potential infection.

Methods

Using nationally representative data from the COVID-19 module of the Brazilian National Household Sample Survey (Pesquisa Nacional por Amostra de Domicílios), collected between July and November of 2020, we examined the association between living arrangements and exposure to and testing for COVID-19 among 63,816 Brazilians aged 60 years and older. We examine whether living arrangements influence self-reported COVID-19 symptoms as an indicator of subjective health assessment, testing as an indicator of health care service use, and a positive COVID-19 test result as an objective indicator of exposure to the disease.

Results

Living arrangements shape older adults’ vulnerabilities to COVID-19 exposure and testing. Specifically, those living alone were more likely to report having symptoms and having had a test for COVID-19. However, older adults in multigenerational and skipped generation households were more likely than solo-dwellers to test positive for COVID-19. Those with symptoms were more likely to test, regardless of their living arrangement. Among older adults without symptoms, those living alone had a higher probability of testing than those living in multigenerational or skipped-generation households.

Conclusions

Overall, our findings suggest that coresidence with younger family members puts older adults’ health at risk in the context of COVID-19. As younger Brazilians are increasingly vulnerable to COVID-19 and experiencing severe outcomes, policy makers need to be more attentive to the health needs of households that comprise older and younger cohorts, which are also more prevalent in poor and marginalized segments of the population.

Tooth loss and associated self-rated health and psychological and subjective wellbeing among community-dwelling older adults: A cross-sectional study in India

Background

Losing teeth has been considered as part of normal aging. However, in developing countries, tooth loss among older adults is shown to be more negatively associated with self-image and quality of life compared to their western counterparts. This study examines the association of tooth loss with self-rated health and psychological and subjective wellbeing among older adults in India.

Methods

Data were derived from the "Building Knowledge Base on Population Ageing in India" (BKPAI) survey which was carried out in 2011. The final sample size for the analysis was 9231 older adults. Descriptive statistics and bivariate analysis along with binary logistic regression analysis were conducted to fulfil the objective of the study.

Results

A proportion of 12.3% of older adults reported complete tooth loss. It was found that older adults who reported tooth loss were 2.38 times significantly more likely to have poor self-rated health (SRH) [2.38; CI: 1.99,2.83] than older adults who did not report tooth loss. The odds of low psychological health were high among older adults who suffered from tooth loss than their counterparts [OR: 1.59; CI: 1.33,1.91]. Older adults who reported tooth loss had 65% significantly higher odds of low subjective well-being than older adults who did not report tooth loss [OR: 1.65; CI: 1.38,1.97].

Conclusion

Complete loss of teeth is associated with older individuals’ poor SRH as well as low psychological and subjective well-being, but such a consequence is avoidable by practising the efforts to maintain good oral health.

Migration of adult male children and associated depression among community-dwelling older parents: A cross-sectional gender analysis from Longitudinal Ageing Study in India, 2017-2018

OBJECTIVES

This study empirically examines the association of migration of an adult male child (ren) on the mental health of the older parents left behind. It also examines the interaction effects of sex of older parents and male child migration on major depression to explore whether there is a gender differential in the possible association.

METHODS

The data for this study were obtained from the first wave of the Longitudinal Ageing Study in India (LASI, 2017-2018). The total sample size for the present study was 27,248 older adults aged 60 years and above (male-12,624; female-14,624). Descriptive statistics along with cross-tabulation were presented. Proportion test was used to evaluate the significance level of differences in depression by sex. Additionally, binary logistic regression analysis was used to find out the associations. Major depression with symptoms of dysphoria, was calculated using the Short-Form Composite International Diagnostic Interview (CIDI-SF).

RESULTS

About 10.5% and 9.0% of older males and females had migrant sons. It was found that there was significant gender differential in depression in older age (male: 7.5% and female: 9.7%; p < 0.001). It was further found that the prevalence of depression was found among older men (9.3% vs. 7.3%) and women (12.5% vs. 9.4%) with migrant son. Older adults with migrant son had 26% significantly higher likelihood to be depressed in reference to older adults with non-migrant son (AOR: 1.26; CI: 1.02-1.56). Further, older women with a migrant son had 76% significantly higher likelihood to be depressed in reference to older men with migrant son (AOR: 1.76; CI: 1.32-2.39).

CONCLUSIONS

This study invites policymakers' attention towards migration of adult children and its potential effects on mental health of left-behind older parents in community-settings and in women in particular. Policies should focus on spreading awareness to migrant children of older adults on maintaining frequent contacts and visits to their ageing parents.

Associations between Disability in Activities of Daily Living and Social Capital aspects among older adults: a scoping review

Social capital aspects are playing an important role in activities of daily living (ADL) performance, thus on independent living. This paper was aimed to present an overview of the associations and adverse effects between social capital aspects and disability in ADL and health-related quality of life (HRQoL) in an older population aged 65 years old and over. Α scoping review was designed following the guidelines of PRISMA Extension for Scoping Reviews (PRISMA-ScR) and the review was conducted by 3 authors. A total of 185 primary studies were extracted and, finally, 40 studies did meet the inclusion criteria and critically appraised in two main categories; Category 1(29 studies) ‘social capital and disability in ADL’ deducing that as greater a social capital as better ADL performance and Category 2 (11 studies) ‘Social capital and HRQoL’ concluding that people 65 years old and over with lower social capital were presented with a poor HRQoL. Study synthesis highlights the impact of social capital suggesting that nurses caring for older people must focus on their engagement in terms of social diversity and trust in the community.

Views and experiences of adult children concerning intergenerational relationships with their older kin: a qualitative study from South India

The tradition of intergenerational care and support exchanges in Indian families is assumed to be disturbed because of changes in family structure brought on by modern life, which is mainly based on studies investigating experiences of older adults regarding the impact of socio-economic change on their care arrangement. However, there is a large gap in understanding the experiences of adult children from a larger relational perspective, more than just care provision to their older relatives. Drawing on 26 in-depth interviews with adult children living in modern and traditional living arrangements from South India, the study explores their experiences with their parents with regard to reciprocity of care and support, the challenges they experience and strategies they adopt to overcome those challenges. The analysis shows adult children perceive the increased demands of modern work life and their older kin's preferences to be heard, lack of flexibility and related extra domestic work and costs, do cause a bigger burden for them in both living arrangements. However, adult children strive to uphold the traditional values of caring for their older kin and sharing emotional bonding with them. This inspiration helps them to employ strategies to accept their older relatives as they are, focus their attention on the benefits they receive from them and distribute care tasks with other relatives to overcome the challenges.

Health disparities among older women in India during the COVID-19 pandemic

Purpose

Older women in India continually experience disparities in health. The legally enforced lockdown in India has impacted both physical and psychosocial well-being of the populace. Amid the restrictions on mobility during the lockdown, older adults are presented with challenges such as impaired access to healthcare services, nonavailability of attendants and prolonged social isolation. Due to these challenges, disparities related to gender and age may considerably widen. The potential health threats may particularly afflict older women, who bear a disproportionate threat to illnesses, compared to their male counterparts.

Design/methodology/approach

This commentary explores how health threats among older Indian women may have worsened during the lockdown. The authors also propose recommendations for expanding health and social care to older women in India.

Findings

Approaches aimed at strengthening gerontological social work must be duly adopted, especially during the ongoing pandemic. Public institutions and development partners should utilize and if needed, overhaul existing resources and policies to adequately serve this marginalized group. Older women, especially those residing in unbearable circumstances, should be identified and brought under comprehensive care coverage within the social landscape.

Originality/value

This article proposes recommendations to foster gerontological social work among older Indian women.

Height and quality of life among older adults (50+) in India: a cross-sectional study

Adult height is a summary measure of health and net nutrition in early childhood. This study examines the association between height and quality-of-life outcomes in older adults (50+) in India. Cross-sectional data from Wave 1 of the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) conducted in 2007 were analysed. The association between height and quality of life was assessed using bivariate and multivariate logistic and linear regression models. The mean WHO quality-of-life score (WHO-QoL) increased from 45.2 among the older adults in the lowest height quintile to 53.2 for those in the highest height quintile. However, the prevalence of self-rated poor quality of life declined from 16.4% in the lowest height quintile to 6.1% in the highest height quintile. In the fully adjusted regression model, height was found to be positively associated with quality-of-life outcomes among both men and women, independent of socioeconomic and physical health confounders. The association was particularly strong for women. Women in the highest height quintile had a 2.65 point higher WHO-QoL score than those in the lowest height quintile. Similarly, the likelihood of reporting a poor quality of life was lower among women in the highest height quintile. Furthermore, measures of economic status, handgrip strength, cognitive ability and poor self-rated health were significantly associated with WHO-QoL and self-rated poor quality of life. Overall, this study revealed a significant association between height and quality of life among older adults in India, suggesting a significant role of childhood circumstances in quality of life in later life.

Nursing Staff's Knowledge and Attitudes towards Dementia in an Indian Nursing Home: A Qualitative Interview Study

Background

Despite the increased prevalence of dementia in India, there is reported to be little awareness of the disease. This could lead to a late diagnosis, a reduced number of choices regarding future care, and misinterpretation of the symptoms or neglect. Taking into consideration that most nurses caring for older people in the future will work with people with dementia, there is concern that they may not be able to meet the needs of this group of patients unless they have the necessary knowledge and a positive attitude.

Aim

To explore the knowledge about and attitude towards dementia among nursing staff working in residential care facilities for older people in India.

Method

An explorative and descriptive qualitative design was used. Two semi-structured focus group interviews were conducted with nursing staff working in 6 nursing homes in India. Qualitative content analysis was used. Ethical approval was granted by the Norwegian Social Science Data Services.

Findings

The participants highlighted the following 3 dimensions in relation to their knowledge of and attitudes toward dementia in residential care facilities in India: (1) people with dementia − a walking mystery; (2) we need to go along with them, but it is challenging; and (3) if we know, we can care for them in a better way.

Conclusion

The findings revealed a wide range of differences in attitude towards and inadequate knowledge of dementia among nursing staff. However, their overall attitudes toward people with dementia was positive.

The Patterns of Caregiving Activities for Family Caregivers of Older Adults in Hong Kong: An Exploratory Latent Class Analysis

OBJECTIVES

This study identified the classes (i.e., patterns) of caregivers' activities, based on their engagements in caregiving activities, and explored the characteristics and the caregiver burden of these classes.

METHODS

This study was a secondary analysis of a cross-sectional survey on the profiles of family caregivers of older adults in Hong Kong. A latent class analysis approach was adopted to classify family caregivers (N = 932) according to their routine involvements in 17 daily caregiving activities: 6 activities of daily living (ADLs) and 8 instrumental activities of daily living activities (IADLs) in addition to emotional support, decision making, and financial support. Multinomial logistic regression and multiple linear regression illuminated the characteristics of the classes and compared their levels of caregiver burden.

RESULTS

The family caregivers fell into 5 classes: All-Round Care (High Demand, 19.5%), All-Round Care (Moderate Demand, 8.2%), Predominant IADLs Care (High Demand, 23.8%), Predominant IADLs Care (Moderate Demand, 32.5%), and Minimal ADLs and IADLs Care (Low Demand, 16.0%). These classes exhibited different characteristics in terms of care recipients' cognitive statuses and caregiver backgrounds. The levels of caregiver burden differed across classes; the All-Round Care (High Demand) class experienced the highest levels of caregiver burden.

DISCUSSION

This study contributes to existing scholarship by turning away from a predefined category of care tasks to explore the patterns of caregiving activities. By identifying caregiving activity patterns and understanding their associated characteristics and caregiver burden, prioritizing and targeting caregiver support interventions better is possible.

Factors associated with low contraceptive use amongst vulnerable mothers in South West State, Nigeria

Background

Young mothers tend to be more prone to high maternal and perinatal risks and are thus deemed vulnerable to adverse sexual and reproductive health rights (SRHR) in terms of their right to choose contraceptives of their choice to enhance their maternal well-being and childbirth spacing should be well discussed. Achieving sufficient SRHR may be averted if the use of family planning by disadvantaged groups is not given required attention.

Aim

This study aimed to identify and analyse the factors associated with the low use of contraceptives amongst vulnerable women in the South West region in Nigeria.

Setting

The study area was purposively chosen to capture contraceptive use amongst vulnerable women in Osun State, Nigeria.

Methods

A primary data collection was done in three senatorial districts of Osun State, Nigeria, with 140 respondents each to give a total of 420 respondents. Collected data were analysed using univariate, bivariate and multivariate measures.

Results

The result showed a magnitude of association and relationship at both levels of analyses. Living arrangements and family types were 89% and 88.3%, respectively, associated with family planning use. In the same vein, living arrangement and family types were also statistically significant at p < 0.05with an odds ratio of 0.23 (95% CI: 0.1184–0.4583) and an odds ratio of 0.35 (95% CI: 0.1756–0.6970) with family planning use, respectively.

Conclusion

We concluded that policies and interventions to accelerate and encourage contraceptives use amongst vulnerable mothers in South West, Nigeria should be targeted at those whose husbands lived elsewhere and those whose husbands have more than one wife.

Ageing and Values in the Developments of Home-Based Eldercare: Perspectives from India and Sweden

Ageing population is becoming a major concern because of its economic, political and social impact. Trusted eldercare service is an important issue for a matured nation. The paper addresses the preconditions of healthy ageing and sustainable value integrated eldercare in a developing and a developed society. In India, professional eldercare is about a decade old and is still emerging to get a foothold in the health care system. The aim is to explore understanding and values of home-based eldercare (HBEC) in India from a multiple stakeholder’s perspective and to understand the value related challenges and issues in developments with HBEC in Sweden which has a century old experience of professional and public organised eldercare. The study included 210 in-depth interviews, 105 each from India and Sweden. The in-depth interviews of various stakeholders including older individuals, their relatives, caregivers, managers and doctors. Interviews and focused group discussions were carried out across six cities in India and 10 municipalities in Sweden. The qualitative data were analysed to conceptualise the stakeholders understanding of HBEC, the values associated with care giving, perceived challenges and issues in the emerging HBEC sector in India. The findings highlight the changing values in the societies with relation to the needs and context of eldercare in both countries. These preconditions for compassion and work engagement in care giving as well as competence development in caregivers need to be strengthened in the contexts of care and in alignment with sociocultural values.

Caregiving tasks and unmet supportive care needs of family caregivers: A U.S. population-based study

OBJECTIVE

To describe the type of care provided by a nationally-representative sample of informal caregivers, the frequency of unmet supportive care needs, and examine characteristics associated with unmet needs.

METHODS

Using data from the Health Information National Trends Survey, we identified caregivers of an adult care recipient. Descriptive statistics examined support provided by caregivers for activities of daily living (ADLs) and instrumental activities of daily living (IADLs) and caregiver perceptions of their needs in five areas: medical/nursing tasks, accessing services, respite care, support groups, and counseling for caregivers. Bivariate statistics examined sociodemographic and caregiver characteristics associated with each need.

RESULTS

Among 316 caregivers, 30.9% reported at least one unmet supportive care need. Caregivers most often provided support for 0-2 ADLs and 5-7 IADLs. Younger age and longer duration of time caregiving were associated with unmet supportive care needs for medical/nursing training (p = 0.02 and 0.04, respectively). Caregivers providing assistance with more ADLs reported needs for respite care support (p=0.03).

CONCLUSION

Subgroups of caregivers that may be most vulnerable with greater unmet supportive care needs are those that are younger, have provided care for longer, and those assisting with more ADLs. Future research should explore these factors to inform intervention development.

Reciprocity between older adults and their care-givers in emigrant households of Kerala, India

The felt obligation to return a benefit, termed reciprocity, has been identified as motivating care exchanges between older adults and their younger family members. Within the context of large-scale emigration of young adults from the Indian state of Kerala, this study examines how left-behind older adults and their family care-givers recognise, interpret and give meaning to reciprocal exchanges, expectations and obligations in their care relationship. Employing a social exchange perspective, we qualitatively explore the norm of reciprocity through in-depth interviews of 48 participants (older adults and their care-givers) from emigrant households. Older adults and their care-givers identified reciprocal notions in their care exchange relationship that provided an interpretive framework for describing expectations, motivations, obligations and experiences across care-giving relationships. Spousal care-givers derived reciprocal motives and mutual care obligations through the institution of marriage. Adult children recognised filial duties and responsibilities and were in principle prepared to provide care to their parents. Reciprocating the support received and the likelihood of intergenerational transfers motivated care exchanges from adult children to their older parents. Daughters-in-law executed transferred filial roles from their emigrant husbands and bore a larger burden of care. Primary adult care-givers relied on the ‘demonstration effect’, hoping that children observe the care-giving process and emulate it later. Imbalances and non-reciprocity in the care exchange led to frustrations and threatened the care relationships.

Engagement in Everyday Activities among People Living in Indian Nursing Homes: The Association with Person-Centredness

Introduction

It has been reported that residents living in nursing homes are often inactive and lonely and are offered a limited number of activities. However, high engagement in activities has been reported to improve residents' quality of life and engagement in personalized activities can even reduce agitation and enhance positive mood. Information regarding occupational patterns and purpose in life is well established in Western countries. However, we know next to nothing about how people living in Indian nursing homes spend their days.

Objective

To explore the participation in everyday activities among older people in Indian nursing homes and the extent to which engagement in activities is associated with person-centred care.

Methods

The study was conducted in 6 nursing homes in India, comprising 147 residents. In all, 23 nursing staff took part and completed a 26-item questionnaire about resident activities based on the Multi-Dimensional Dementia Assessment Scale and the Person-Directed Care Questionnaire. Person-centredness was measured with the Person-Centred Care Assessment Tool.

Results

We found low participation in everyday activities among the residents. Participation in religious activities was the most frequent, whereas the least used activities were excursions, participating in cultural activities, taking part in educational programmes, visiting a restaurant and going to the cinema. A significant positive association was found between person-centred care and participation in religious activities, engagement in an activity programme and physical activity.

Conclusions

The most frequently attended activity was religious activities. Person-centred care was associated with participation in religious activities, engagement in an activity programme, physical activity, spending time in the garden and playing and listening to music.

Aging in e-place: reflections on online communities for the aged in India

In this short piece, I offer a reconfiguration of the term "aging in place" by analyzing media content of web-based senior-focused portals while demonstrating how these online consumer-driven spaces unwittingly re-create new social relations and imagined communities. Building on the sparse body of scholarship on extra-familial, kin-like networks, I reflect on the cultural possibility of internet spaces as surrogate "places" for later life non-kin sociality. In this exploration, I privilege the possibility of enriched selfhood of older Indians by moving away from the conventional gerontological trope of the (Indian) elderly as indivisible familial subjects, as a deliberate process of decolonizing the field of gerontology.

Nursing Staff's Knowledge and Attitudes toward Dementia: A Pilot Study from an Indian Perspective

Background

Despite the increased prevalence of dementia in India, reports indicate little awareness of the disease. Symptoms are often misinterpreted or neglected, which could lead to late diagnosis, reducing the choices available regarding future care. Considering that most nurses caring for the elderly will work with people with dementia in the future, there is concern surrounding their ability to meet the needs of these patients, requiring them to obtain the necessary knowledge and positive attitudes for treatment.

Aims

To describe the knowledge of and attitudes toward dementia among nursing staff working in residential care facilities for elderly populations in India.

Methods

A cross-sectional survey was conducted in 3 nursing homes in India in which 15 nursing staff conducted self-assessments of their knowledge and attitudes toward dementia using the Alzheimer's Disease Knowledge Scale (ADKS) and the Attitude toward Alzheimer's Disease and Related Dementias Scale (DAS) for each respective assessment. Descriptive statistics were used to describe staffs' attitudes and knowledge concerning dementia. Continuous variables were presented as means ± SD, while the categorical variables were presented as percentages.

Results

Although the majority of the participants answered that Alzheimer's disease cannot be cured, about half reported that people with dementia, in rare cases, can recover from the disease. While all participants agreed that people with dementia can feel when others are kind to them, almost half disagreed that people living with dementia can enjoy life.

Conclusion

These findings reveal that nursing staff have limited knowledge of dementia, but their attitudes toward people living with dementia tend to be positive.

The Relationship of Workplace Flexibility to Employee Engagement among Information Technology Employees in India

Historically, organizations have been provisioning flexible work arrangement (FWA) options in the workplace to help employees achieve a balance between work obligations and private obligations. We explore the utilization of FWA offerings in the Indian information technology (IT) industry and its relation to employee engagement (EE). Employees working in IT organizations in Bengaluru, India, were approached and data were obtained from 504 participants. The study found that availability of FWA options coincided with their utilization. Disconcertingly, only 7 per cent of the employees were “highly engaged”, 51 per cent were neither engaged nor disengaged and 41 per cent of the employees were disengaged with their current organization. FWAs were positively related to EE. We find congruence that FWA options lead to better EE warranting further exploration that can guide FWA policies.

Living Alone among Older Persons in Uganda: Prevalence and Associated Factors

This study aimed at investigating the prevalence and factors associated with living alone among older persons in Uganda. A secondary analysis of the 2010 Uganda National Household Survey (UNHS) data was conducted. A complementary log-log regression model was used to estimate the association between living alone and demographic, socio-economic and health factors. Nearly one out of ten (9%) older persons lived alone in Uganda. Living alone was associated with being divorced / separated (OR 18.5, 95% CI: 10.3–33.3), being widowed (OR 8.8, 95% CI: 5.1–15.2), advanced age (OR 2.1, 95% CI: 1.4–3.2), residence in western region (OR 0.6, 95% CI: 0.3–0.93), poor wealth status (OR 0.3, 95% CI: 0.2–06), receiving remittances (OR 1.6, 95% CI: 1.1–2.3) and being disabled (OR 1.6, 95% CI: 1.2–2.1). Living alone among older persons did not vary by gender.